Dentists are being reminded of the potential drug interaction between the antifungal miconazole (Daktarin, Daktacort) and the blood thinning medication warfarin.

Miconazole, including the topical gel formulation, can enhance the anticoagulant effect of warfarin—if miconazole and warfarin are used concurrently, the anticoagulant effect should be carefully monitored and, if necessary, the dose of warfarin reduced.

Patients should be advised to tell their doctor or pharmacist if they are receiving warfarin before using products that contain miconazole (including those available without prescription), and to seek medical advice if they notice signs of over-anticoagulation during treatment, such as sudden unexplained bruising, nosebleeds or blood in the urine.

The Medicines and Healthcare Products Regulatory Agency (MHRA) have issued the reminder in their monthly drug safety update following a Patient Safety Notice issued in Wales last month which describes a fatality in a patient on warfarin who was prescribed miconazole oral gel by her dentist.

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